Posted on 10/26/2026
The AHCCCS Solutions Center (ASC) will be temporarily unavailable on Sunday, November 8, from 3:00 AM to 9:00 AM Arizona Time due to a planned system upgrade. During this time, users will be unable to access the ASC. We apologize for any inconvenience and appreciate your patience as we complete these system improvements.
AHCCCS has initiatives to identify and prevent improper payments before claims are processed. One of these initiatives is prepayment review, which is currently applied consistently to the following service categories:
Prepayment review requires clinical documentation, such as treatment plans, assessments, progress notes, and transportation trip tickets, to be submitted to AHCCCS for review before the claim is adjudicated.
Depending on the service type, prepayment reviews are completed by AHCCCS staff, contractors, or both, with limited assistance from artificial intelligence to identify claims.
Prepayment review requirements may apply to various claim elements, including diagnosis, service type, and provider ID. When a non-provider-specific claim element, such as a service code, is placed on prepayment review, AHCCCS sends a Constant Contact email alert to the provider community. To receive these alerts, visit the claims clues webpage and select “Subscribe to e-news from DFSM.”
When a code on prepayment review is defined by a time frame, providers should generally assume that services, lasting more than one hour, require prepayment review.
The AHCCCS audit team notifies provider organizations and individual professionals by letter when they are placed on prepayment review. Providers remain on review until their medical records consistently meet minimum passing thresholds of 85% for behavioral health providers and 97% for transportation providers. Meeting these thresholds qualifies providers for consideration for removal from prepayment review. Other considerations include Quality Management corrective action plans, OIG actions, and participation in training and technical assistance.
When submitting documents for prepayment review, always use a PWK number so the documents can be linked to the claim. Each claim may be linked to only one PWK number. If other alternatives are utilized, other than PWK, the provider may experience longer than anticipated processing times or risk of having the claim denied, due to the system not able to link documentation to the claim.
When submitting a reconsideration, the provider must submit a new claim that includes the resubmission code in Box 22 and references the original claim number in Box 22. The resubmission voids the original claim and helps prevent a duplicate claim denial. The provider must also resubmit all required documents using a new PWK number. AHCCCS recommends using the member ID and date of service format, with the letter “R” added at the end to indicate reconsideration.
